nyagra

Advocates For Freedom of Gender Identity And Expression For All
24 W. 25th Street, 9th Floor; New York, NY 10010; 212-675-3288 ext#338; fax 212-675-3466
Friday July 30th 2010

Join NYAGRA

The New York Association for Gender Rights Advocacy Membership Application Form

This information is kept confidential. Members will receive our newsletter and ongoing announcements via e-mail regarding NYAGRA’s activities. You do not have to reside in the state of New York to join NYAGRA.

INSTRUCTIONS:

At this time, please complete the fields on the form below and then click SEND. Once you get a confirmation page — your application has been received. From there, please send your payment via snail mail. Make your check or money order payable to NYAGRA.

Mail to: NYAGRA, 24 W. 25th St, 9th floor, New York, NY 10010

Contact Name (required)

Membership Card Name (required)

Telephone (required)

Street Address (required)

City, State, Zip Code (required)

Your Email (required)

Gender Identity (opt)

Sexual orientation (opt)

Age (opt)

Ethnicity/Race (opt)


Membership Options (please pick one):

$20 basic annual membership

$10 annual membership (students, senior citizens, limited income

I want to be a NYAGRA member but need a fee waiver

I want to make an additional tax-deduction contribution of $

_______________________________________________________________

Payment Method (please check one):




At this time, please mail your check or money order to the NYAGRA address


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